A case of asymptomatic UPJO likes USGs

• 28 Jul 2020 11:34:31 AM
• |Pediatic Urology

2 years female child. 

Comments(10)

• 

  Uday Sankar Chatterjee

  28 Jul 2020 05:59:06 PM

  
  

  
  

  
  

      1. I would not do MCU in this patient.

  2. No CT uro as well.

  
  

  
  

  3. Wait and watch

  4. Monitor with USG Renometry. Any feature of deterioration, do Venogram for SRF, if deterioration > 5% do Pyeloplasty.

  
  

  5. Otherwise, follow-up with USGR...With increasing interval for at least 20 years.

  
  

  
  

  
  

  .

• 

  Dr. Anil Takvani

  28 Jul 2020 06:08:44 PM

  @ Dr. Udayshankar Sir,

  Thanks.

  Requesting you to provide details, How exactly you do USG renometry?

• 

  Uday Sankar Chatterjee

  28 Jul 2020 07:03:51 PM

  
  

  
  

  
  

      USGR: 

  1 Cortical thickness UP/MP/LP

  2. Caliceal dilation UP/MP/LP

  3. APD

• 

  Tikenjit Mazumdar

  28 Jul 2020 09:27:49 PM

  Uday Sankar sir,I didn't understand your point for waiting here when subsequent usg showing increase in AP diameter n renogram showing obstructive flow?? Plz enlightened a bit in this

• 

  Uday Sankar Chatterjee

  28 Jul 2020 11:06:44 PM

  
  

  
  

  
  

  
  

  1. Obstructive curve & Deterioration in USGR parameters point towards the possibilities of  functional deterioration. 

  
  

  
  

  Renogram confirms... So decision evolves from Renogram.

  
  

• 

  Uday Sankar Chatterjee

  28 Jul 2020 11:09:05 PM

  
  

  
  

  I.e. SFR in renogram... Not the obstructive curve alone.

• 

  Venugopal P

  29 Jul 2020 09:51:23 AM

  Dear All,

  I am a little intrigued by Udaysankar’s suggestion to perform ‘Venogram for assessing Split Renal Function’ I am sorry at my lack of knowledge. It only shows that no one has climbed ‘Sarvatgna Peeda’ and everyone will have to learn considerably more.

  I would appreciate if I could be enlightened on Venogram for measuring SRF.

  Sorry for my ignorance,

  Venu

• 

  Dr. Anil Takvani

  29 Jul 2020 10:04:42 AM

  Sir, 

  Venogram is just typing mistake. 

  He wanted to write renogram for split renal function....

  Thanks 

• 

  Gyanendra Sharma

  29 Jul 2020 12:50:00 PM

  Dear Anil

  I look at 3 things to decide need for surgical intervention

  1. AP Diameter of renal pelvis  & calyces in supine & prone
  2. CTT
  3. NORA

  Here AP Diameter in supine & prone is not available & NORA is usually not given by most of the nuclear medicine centers

  From the images  it looks  like CTT is > 3 minutes--but picture is not clear

  If you ask me from the given information--I would offer pyeloplasty as the hydronephrosis is increasing, kidney size is increasing & parenchymal thickness is decreasing

  
  

• 

  Dr. Anil Takvani

  29 Jul 2020 06:30:17 PM

  Thanks Gyanendra. 

  CTT is prolonged.

  If you look at post void , post standing position images there is significant hold up of isotope.  And same thing is very much there in one hour delayed image. 

  Do you think these findings in diuretic scan are crutial in decision making?...thanks